Technique of computed tomography guided chemical lumbar sympathectomy for peripheral vascular disease-a study of its efficacy in the Indian population

Abstract

Background: Surgical lumbar sympathectomy is an established procedure in the treatment of peripheral vascular disease for patients with severe rest pain and where revascularization is not possible. The aim of the present study is to evaluate the efficacy of chemical lumbar sympathectomy using computed tomography (CT) guidance in the Indian population. Methods: A prospective study was done on 22 patients with inoperable peripheral vascular disease in Coimbatore medical college hospital, Coimbatore between June 2013 and May 2015. Using Toshiba 4-slice helical CT guidance and absolute alcohol as neurolytic solution, chemical lumbar sympathectomy was performed at single level. Rest pain was assessed by visual analogue scale. Size of the ischemic ulcers were measured before and 2 months after the procedure. Results: At 2 months post procedure, 77 % of patients reported substantial relief of rest pain. In 57% of patients, there was significant reduction in size of the ulcers. Conclusions: Lumbar sympathectomy has still got a specific role in modern vascular surgery practice. The precision of computed tomography guidance in chemical neurolysis is unparalleled. It is safe, as effective as surgical sympathectomy and can be quickly performed as an out-patient procedure with local anaesthesia. It is a valuable technique that can be easily mastered by the radiologist doing interventional procedures using computed tomography.